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Article ; Online: Gastric tube cancer after esophagectomy for cancer: a systematic review.

Gentile, Damiano / Riva, Pietro / Da Roit, Anna / Basato, Silvia / Marano, Salvatore / Castoro, Carlo

Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus

2019 Volume 32, Issue 8

Abstract: Gastric conduit used for reconstruction after esophagectomy for cancer has the potential to develop a metachronous neoplasm known as gastric tube cancer (GTC). The aim of this study was to review literature and evaluate outcomes and possible treatment ... ...

Abstract	Gastric conduit used for reconstruction after esophagectomy for cancer has the potential to develop a metachronous neoplasm known as gastric tube cancer (GTC). The aim of this study was to review literature and evaluate outcomes and possible treatment strategies for GTC. A comprehensive systematic literature search was conducted using PubMed, EMBASE, Scopus, and the Cochrane Library Central Register of Controlled Trials. No restriction was set for the type of publication, number, age, or sex of the patients. The search was limited to articles in English. Characteristics of esophageal cancer (EC) and its treatment and GTC and its treatment were analyzed. A total of 28 studies were analyzed, 12 retrospective analyses and 16 case reports, involving 229 patients with 250 GTCs in total. The majority of ECs (88.2%) were squamous cell carcinomas. In 120 patients (52.4%) a posterior mediastinal reconstructive route was used when esophagectomy was performed. The mean interval between esophagectomy and diagnosis of GTC was 55.8 months, with a median interval of 56.8 months (4-236 months). One hundred and twenty-four GTCs (49.6%) were located in the lower part of the gastric tube. One hundred and forty patients were endoscopically treated. Eighty-five patients underwent surgery. Thirty-six total gastrectomies with lymphadenectomy with colon or jejunal interposition were performed. Forty-three subtotal gastrectomies and 6 wedge resections were performed. The main reported postoperative complications were anastomotic leak, vocal cord palsy, and respiratory failure. Twenty-five patients were treated with palliative chemotherapy. Three-year survival rates were 69.3% for endoscopically treated patients, 58.8% for surgically resected patients, and 4% for patients who underwent palliative treatment. The feasibility of endoscopic resections in patients diagnosed with superficial GTC has been reported. Surgical treatment represented the preferred treatment method in operable patients with locally invasive tumor. Patients treated with conservative therapy have a scarce prognosis. The development of GTC should be taken into consideration during the extended follow-up of patients undergoing esophagectomy for cancer. Total gastrectomy plus lymphadenectomy should be considered the preferred treatment modality in operable patients with locally invasive tumor, when endoscopy is contraindicated. Long-term yearly endoscopic follow-up is recommended.
MeSH term(s)	Adult ; Aged ; Carcinoma, Squamous Cell/pathology ; Carcinoma, Squamous Cell/surgery ; Esophageal Neoplasms/pathology ; Esophageal Neoplasms/surgery ; Esophagectomy/adverse effects ; Esophagectomy/instrumentation ; Female ; Gastrectomy/methods ; Humans ; Intubation, Gastrointestinal/adverse effects ; Male ; Middle Aged ; Neoplasms, Second Primary/etiology ; Neoplasms, Second Primary/surgery ; Postoperative Complications/etiology ; Postoperative Complications/surgery ; Retrospective Studies ; Stomach Neoplasms/etiology ; Stomach Neoplasms/surgery ; Treatment Outcome
Language	English
Publishing date	2019-05-21
Publishing country	United States
Document type	Journal Article ; Systematic Review
ZDB-ID	639470-x
ISSN	1442-2050 ; 1120-8694
ISSN (online)	1442-2050
ISSN	1120-8694
DOI	10.1093/dote/doz049
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Article: Managing the Consequences of Oncological Major Surgery: A Short- and Medium-Term Skills Assessment Proposal for Patient and Caregiver through M.A.D.I.T. Methodology.

Turchi, Gian Piero / Fabbian, Alessandro / Alfieri, Rita / Da Roit, Anna / Marano, Salvatore / Mattara, Genny / Pilati, Pierluigi / Castoro, Carlo / Bassi, Davide / Dalla Riva, Marta Silvia / Orrù, Luisa / Pinto, Eleonora

Behavioral sciences (Basel, Switzerland)

2022 Volume 12, Issue 3

Abstract: The effects of cancer surgery and treatment harm patients' life and working ability: major causes of this can be intensified by the postoperative symptoms. This study, the first part of the HEAGIS project (Health and Employment after Gastrointestinal ... ...

Abstract	The effects of cancer surgery and treatment harm patients' life and working ability: major causes of this can be intensified by the postoperative symptoms. This study, the first part of the HEAGIS project (Health and Employment after Gastrointestinal Surgery), proposes a method to assess patients and caregivers' competences in dealing with postoperative course and the related needs to improve the adequate competences. In this observational study, an ad hoc structured interview was conducted with 47 patients and 15 caregivers between the third and fifteenth postoperative day. Oesophageal (38%), esophagogastric junction (13%), gastric (30%), colon (8%) and rectum (11%) cancer patients were considered. Computerized textual data analysis methodology was used to identify levels of competences. Text analysis highlighted three different levels (low, medium and high) of four specific types of patients and caregivers' competences. In particular, the overall trend of the preview of future scenarios and use of resource competences was low. Less critical were situation evaluation and preview repercussion of own actions' competences. Caregivers' trends were similar. The Kruskal-Wallis test did not distinguish any differences in the level of competences related to the characteristics of the participants. Patients and caregivers are not accurate in planning the future after surgery, using personal beliefs rather than referring to physicians, and not recognizing adequate resources. The medium-low competences' trend leads to unexpected critical situations, and patients could not deal with them in a maximally effective way. Both patients and caregivers should be taken over by healthcare professionals to improve patients' competences and make the curative surgery effective in daily life.
Language	English
Publishing date	2022-03-15
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2651997-5
ISSN	2076-328X
ISSN	2076-328X
DOI	10.3390/bs12030077
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Article: Critical Competences for the Management of Post-Operative Course in Patients with Digestive Tract Cancer: The Contribution of MADIT Methodology for a Nine-Month Longitudinal Study.

Pinto, Eleonora / Fabbian, Alessandro / Alfieri, Rita / Da Roit, Anna / Marano, Salvatore / Mattara, Genny / Pilati, Pierluigi / Castoro, Carlo / Cavarzan, Marco / Dalla Riva, Marta Silvia / Orrù, Luisa / Turchi, Gian Piero

Behavioral sciences (Basel, Switzerland)

2022 Volume 12, Issue 4

Abstract: There is a high postoperative morbidity rate after cancer surgery, that impairs patients’ self-management, job condition and economic strength. This paper describes the results of a peculiar psychological intervention on patients undergoing surgery for ... ...

Abstract	There is a high postoperative morbidity rate after cancer surgery, that impairs patients’ self-management, job condition and economic strength. This paper describes the results of a peculiar psychological intervention on patients undergoing surgery for esophageal, gastric and colorectal cancer. The intervention aimed to enhance patients’ competences in the management of postoperative daily life. A narrative approach (M.A.D.I.T.—Methodology for the Analysis of Computerised Text Data) was used to create a questionnaire, Health and Employment after Gastro-Intestinal Surgery—Dialogical Questionnaire, HEAGIS-DQ, that assesses four competences. It was administered to 48 participants. Results were used as guidance for specific intervention, structured on patients’ competence profiles. The intervention lasted nine months after surgery and was structured in weekly to monthly therapeutic sessions. Quality of Life questionnaires were administered too. At the end of the intervention, 94% of patients maintained their job and only 10% of patients asked for financial support. The mean self-perception of health-related quality of life was 71.2. The distribution of three of four competences increased after nine months (p < 0.05). Despite economic difficulties due to lasting symptoms after surgery, and to the current pandemic scenario, a structured intervention with patients let them to resume their jobs and continue activities after surgery.
Language	English
Publishing date	2022-04-09
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2651997-5
ISSN	2076-328X
ISSN	2076-328X
DOI	10.3390/bs12040101
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Article ; Online: Clinical Outcomes of Carotid Endarterectomy in Symptomatic and Asymptomatic Patients with Ipsilateral Intracranial Stenosis.

Ballotta, Enzo / Toniato, Antonio / Da Roit, Anna / Baracchini, Claudio

World journal of surgery

2015 Volume 39, Issue 11, Page(s) 2823–2830

Abstract: Background and purpose: The risk of perioperative stroke and the benefits of carotid endarterectomy (CEA) remain uncertain in the case of an ipsilateral intracranial stenosis. The aim of this observational study was to analyze the early and late ... ...

Abstract	Background and purpose: The risk of perioperative stroke and the benefits of carotid endarterectomy (CEA) remain uncertain in the case of an ipsilateral intracranial stenosis. The aim of this observational study was to analyze the early and late outcomes of CEA in patients with a carotid tandem lesion (CTL), defined as a severe stenosis at the bifurcation with any concomitant lesion ≥50 % involving the intracranial portion of the ipsilateral internal carotid artery or the main trunk of the anterior or middle cerebral artery. Methods: From 2000 to 2009, 1143 patients underwent CEA for symptomatic or asymptomatic extracranial carotid stenosis according to the NASCET and ACAS recommendations, respectively. CTLs were diagnosed in 219 patients (19.2 %) by extracranial and transcranial color-coded Doppler sonography combined with noninvasive brain imaging studies. The primary endpoints of the study were perioperative (30-day) stroke and death, and any ipsilateral ischemic adverse events during the follow-up, which ranged from 0.1 to 10 years (mean 4.9 ± 3.3 years). The rates of the primary endpoints were compared between patients with (group I) and without CTL (group II). Results: Overall, 219 CEAs were performed in group I and 924 in group II. Nearly two in three of the carotid lesions (777 of 1143, 68 %) were symptomatic at presentation (62.1 % in group I vs 69.4 % in group II; p = 0.03), with a 23.8 % rate of stroke (21.9 % in group I vs 24.2 % in group II; p = 0.85). There were 2 (0.9 %) perioperative ipsilateral strokes in group I and 5 (0.5 %) in group II (p = 0.62), and no deaths. The 5-year ipsilateral stroke-free, any stroke-free, and overall survival rates did not differ significantly between patients with and without CTL. Conclusions: This study has shown that patients with and without CTL who underwent CEA had a similar occurrence of perioperative adverse events (probably due to the extremely low incidence of perioperative complications) and comparable late outcomes, suggesting that the presence of CTL does not justify refusing CEA for patients who could benefit from it.
MeSH term(s)	Aged ; Aged, 80 and over ; Anterior Cerebral Artery/diagnostic imaging ; Anterior Cerebral Artery/pathology ; Asymptomatic Diseases/therapy ; Carotid Stenosis/diagnosis ; Carotid Stenosis/surgery ; Constriction, Pathologic/diagnosis ; Constriction, Pathologic/surgery ; Disease-Free Survival ; Endarterectomy, Carotid/adverse effects ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Middle Cerebral Artery/diagnostic imaging ; Middle Cerebral Artery/pathology ; Neuroimaging ; Retrospective Studies ; Stroke/epidemiology ; Survival Rate ; Ultrasonography, Doppler, Color
Language	English
Publishing date	2015-11
Publishing country	United States
Document type	Journal Article ; Observational Study
ZDB-ID	224043-9
ISSN	1432-2323 ; 0364-2313
ISSN (online)	1432-2323
ISSN	0364-2313
DOI	10.1007/s00268-015-3165-7
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Article: Management of Liver Oligometastatic Esophageal Cancer: Overview and Critical Analysis of the Different Loco-Regional Treatments.

Procopio, Fabio / Marano, Salvatore / Gentile, Damiano / Da Roit, Anna / Basato, Silvia / Riva, Pietro / De Vita, Ferdinando / Torzilli, Guido / Castoro, Carlo

Cancers

2019 Volume 12, Issue 1

Abstract: Esophageal cancer (EC) is an aggressive disease that is associated with a poor prognosis. Since metastastic EC is usually considered suitable only for palliative therapy with an estimated 5-year overall survival (OS) less than 5%, the optimal management ... ...

Abstract	Esophageal cancer (EC) is an aggressive disease that is associated with a poor prognosis. Since metastastic EC is usually considered suitable only for palliative therapy with an estimated 5-year overall survival (OS) less than 5%, the optimal management of patients with liver oligometastatic EC (LOEC) is still undefined. The aim of this review is to provide an overview of the different treatment options for LOEC. A literature search was conducted using PubMed, Embase, and Cochrane to identify articles evaluating different treatment strategies for LOEC. Among 828 records that were identified, 20 articles met the inclusion criteria. These studies included patients who have undergone any type of surgical procedure and/or loco-regional therapy. Liver resection resulted in the best survival for patients with low tumor burden (3 lesions): 5-year OS 30-50% versus 8-12% after only chemotherapy (CHT). The 5-year OS of loco-regional therapies was 23% with a local recurrence risk ranging 0-8% for small lesions (2 to 3 cm). An aggressive multidisciplinary approach for LOEC patients may improve survival. Surgery seems to be the treatment of choice for resectable LOEC. If unfeasible, loco-regional therapies may be considered. In order to better select these patients and offer a chance of cure, prospective trials and a definition of treatment protocols are needed.
Language	English
Publishing date	2019-12-19
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2527080-1
ISSN	2072-6694
ISSN	2072-6694
DOI	10.3390/cancers12010020
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Article ; Online: Carotid endarterectomy for asymptomatic carotid stenosis in the very elderly.

Ballotta, Enzo / Toniato, Antonio / Da Roit, Anna / Lorenzetti, Renata / Piatto, Giacomo / Baracchini, Claudio

Journal of vascular surgery

2015 Volume 61, Issue 2, Page(s) 382–388

Abstract: Background: The indication for carotid endarterectomy (CEA) is uncertain in patients with asymptomatic severe (≥60% luminal narrowing according to the North American Symptomatic Carotid Endarterectomy Trial criteria) carotid stenosis (ASCS), especially ... ...

Abstract	Background: The indication for carotid endarterectomy (CEA) is uncertain in patients with asymptomatic severe (≥60% luminal narrowing according to the North American Symptomatic Carotid Endarterectomy Trial criteria) carotid stenosis (ASCS), especially in the very elderly, because current evidence suggests that the risk of future stroke has been dropping in the past two decades owing to the recent advances in medical therapy. The aim of this observational study was to compare early and late outcomes in patients ≥80 years old with ASCS treated with CEA plus best medical treatment (BMT) or with BMT alone. Methods: From 2005 to 2012, 69 octogenarians with ASCS underwent CEA plus BMT (group 1), and another 54 received BMT alone (group 2). All operations were eversion CEAs. BMT included lipid-lowering drugs, new antiplatelet and antihypertensive agents, avoidance of smoking, careful blood pressure and glycemic control, and lifestyle changes. Follow-up with serial ultrasonographic examination was obtained in 118 patients for a median 4.4-year period. Results: There were no perioperative (30-day) strokes or deaths and one transient ischemic attack (1.4%). One late minor stroke developed in a CEA patient (1.5%). No late restenoses or occlusions were detected. Five patients in group 2 (9.6%) became symptomatic (one transient ischemic attack and four minor strokes) and subsequently underwent successful CEA; all their carotid plaques were complicated by ulceration and intraplaque hemorrhage (with plaque progression in four cases), confirmed by computed tomography images. The rate of freedom from cerebral ischemic events at 5 years showed a significant benefit for elderly patients who had CEA vis-à-vis those who did not (98% vs 84%; P = .04), and so did the 5-year rate of freedom from ipsilateral carotid disease progression (100% vs 91%; P = .01). At 5 years, the mortality rate was comparable for elderly patients whether they had CEA or not (66% vs 68%; P = .65). Conclusions: CEA is a safe, effective, and durable treatment for ASCS in patients aged 80 years or more, carrying an insignificant perioperative stroke/death risk. CEA associated with BMT seems preferable to BMT alone in preventing the risk of ipsilateral ischemic events, without translating into a longer survival.
MeSH term(s)	Age Factors ; Aged, 80 and over ; Asymptomatic Diseases ; Cardiovascular Agents/therapeutic use ; Carotid Stenosis/complications ; Carotid Stenosis/diagnosis ; Carotid Stenosis/mortality ; Carotid Stenosis/surgery ; Diagnostic Imaging/methods ; Disease Progression ; Disease-Free Survival ; Endarterectomy, Carotid/adverse effects ; Endarterectomy, Carotid/mortality ; Female ; Humans ; Ischemic Attack, Transient/etiology ; Ischemic Attack, Transient/mortality ; Kaplan-Meier Estimate ; Male ; Patient Selection ; Recurrence ; Registries ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Risk Reduction Behavior ; Severity of Illness Index ; Stroke/etiology ; Stroke/mortality ; Time Factors ; Treatment Outcome
Chemical Substances	Cardiovascular Agents
Language	English
Publishing date	2015-02
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Observational Study
ZDB-ID	605700-7
ISSN	1097-6809 ; 0741-5214
ISSN (online)	1097-6809
ISSN	0741-5214
DOI	10.1016/j.jvs.2014.07.090
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Article ; Online: Durability of eversion carotid endarterectomy.

Ballotta, Enzo / Toniato, Antonio / Da Giau, Giuseppe / Lorenzetti, Renata / Da Roit, Anna / Baracchini, Claudio

Journal of vascular surgery

2014 Volume 59, Issue 5, Page(s) 1274–1281

Abstract: Objective: Carotid endarterectomy (CEA) remains the gold standard for treating carotid disease in selected symptomatic and asymptomatic patients, though carotid angioplasty and stenting has emerged as a safe alternative. The aim of this study was to ... ...

Abstract	Objective: Carotid endarterectomy (CEA) remains the gold standard for treating carotid disease in selected symptomatic and asymptomatic patients, though carotid angioplasty and stenting has emerged as a safe alternative. The aim of this study was to assess the durability of CEA in a large series of patients followed up according to a strict clinical and ultrasonographic protocol. Methods: Over a 23-year period (1990-2012) a total of 1773 patients (1251 men and 522 women) with a mean age of 75.2 years (range, 31 to 96 years) who underwent 2007 consecutive primary eversion CEAs performed by the same surgeon under general anesthesia with electroencephalographic monitoring and selective shunting were prospectively followed up with ultrasonography at 1, 6, and 12 months, then yearly. A long-term follow-up (median, 11.2 years; mean, 12.9 years) was obtained for 1680 patients (94.8%). End points were perioperative (30-day) stroke and death and late carotid restenosis/occlusion rates. Results: More than two in three of the lesions (1446 of 2007, 72.1%) were symptomatic at the time of surgery, with a 25% rate of preoperative stroke. Preoperative antiplatelet or anticoagulant therapy was used by 1675 patients (94.4%), whereas 918 (51.8%) were receiving statin treatment. Overall, there were eight (0.4%) perioperative strokes and no deaths. During the follow-up, there were nine (0.47%) asymptomatic late carotid restenoses (six moderate [50%-69%] and three severe [≥ 70%]) and one (0.05%) carotid occlusion. Nine patients (0.47%) had late ipsilateral strokes, none of them related to restenosis/occlusion. Overall, there were 159 late deaths (9.4%). Conclusions: The results of this study show that eversion CEA can be performed in symptomatic and asymptomatic patients with an extremely low perioperative stroke/death risk and a negligible incidence of late restenosis/occlusion, thus assuring a persistently good protection against the risk of cerebral ischemia.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Anesthesia, General ; Anticoagulants/therapeutic use ; Asymptomatic Diseases ; Brain Ischemia/etiology ; Brain Ischemia/mortality ; Carotid Stenosis/complications ; Carotid Stenosis/diagnostic imaging ; Carotid Stenosis/mortality ; Carotid Stenosis/surgery ; Electroencephalography ; Endarterectomy, Carotid/adverse effects ; Endarterectomy, Carotid/methods ; Endarterectomy, Carotid/mortality ; Female ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Monitoring, Intraoperative/methods ; Platelet Aggregation Inhibitors/therapeutic use ; Recurrence ; Retrospective Studies ; Risk Factors ; Stroke/etiology ; Stroke/mortality ; Time Factors ; Treatment Outcome ; Ultrasonography
Chemical Substances	Anticoagulants ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Platelet Aggregation Inhibitors
Language	English
Publishing date	2014-05
Publishing country	United States
Document type	Journal Article ; Observational Study
ZDB-ID	605700-7
ISSN	1097-6809 ; 0741-5214
ISSN (online)	1097-6809
ISSN	0741-5214
DOI	10.1016/j.jvs.2013.11.088
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Article ; Online: Intestinal Surgery for Crohn's Disease: Role of Preoperative Therapy in Postoperative Outcome.

Scarpa, Marco / Martinato, Matteo / Bertin, Eugenia / Da Roit, Anna / Pozza, Anna / Ruffolo, Cesare / D'Incà, Renata / Bardini, Romeo / Castoro, Carlo / Sturniolo, Giacomo C / Angriman, Imerio

Digestive surgery

2015 Volume 32, Issue 4, Page(s) 243–250

Abstract: Purposes: Patients affected by Crohn's disease (CD) require lifelong medical therapy, but they can also often require abdominal surgery. The effect of CD therapy on postoperative course is still unclear. The aim of this study was to evaluate the effect ... ...

Abstract	Purposes: Patients affected by Crohn's disease (CD) require lifelong medical therapy, but they can also often require abdominal surgery. The effect of CD therapy on postoperative course is still unclear. The aim of this study was to evaluate the effect of preoperative medical therapy on the outcome of intestinal surgery in these patients. Methods: Data from a consecutive series of 167 patients with CD operated on at the University of Padova Hospital from 2000 to 2013 were retrieved. Data of preoperative therapy during the 6 months before surgery were available for 146 patients who were enrolled in this retrospective study. Clinical data and surgical details were retrieved and postoperative complications and reoperation were considered outcome measures. Univariate and multivariate analysis were performed. Results: No significant difference was observed between patients without data about their preoperative therapy and those with them. Eight patients underwent reoperation in the first 30 postoperative days: two of them for anastomotic leak, three for bleeding, one for obstruction and two for abdominal wound dehiscence. At multivariate analysis, preoperative adalimumab and budesonide resulted to be an independent predictor of reoperation (OR = 7.67 (95% CI = 1.49-39.20), p = 0.01 and OR = 6.7749 (95% CI = 0.98-46.48), p = 0.05, respectively). At multivariate analysis neither pharmacological nor clinical variables resulted to predict anastomotic leak. Conclusions: In our series, adalimumab seemed to be associated to early reoperation after intestinal surgery. This may be due to a worst disease severity in patients who needed surgery in spite of biological therapy. Preoperative tapering of budesonide dose seems a safe option before elective abdominal surgery for CD.
MeSH term(s)	Adult ; Aged ; Anti-Inflammatory Agents/adverse effects ; Anti-Inflammatory Agents/therapeutic use ; Combined Modality Therapy ; Crohn Disease/drug therapy ; Crohn Disease/surgery ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Postoperative Complications/chemically induced ; Postoperative Complications/epidemiology ; Postoperative Complications/surgery ; Preoperative Care/adverse effects ; Reoperation ; Retrospective Studies ; Treatment Outcome
Chemical Substances	Anti-Inflammatory Agents
Language	English
Publishing date	2015
Publishing country	Switzerland
Document type	Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
ZDB-ID	605888-7
ISSN	1421-9883 ; 0253-4886
ISSN (online)	1421-9883
ISSN	0253-4886
DOI	10.1159/000381885
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Article ; Online: Sleep disturbances and quality of life in postoperative management after esophagectomy for esophageal cancer.

Scarpa, Marco / Pinto, Eleonora / Saadeh, Luca M / Parotto, Matteo / Da Roit, Anna / Pizzolato, Elisa / Alfieri, Rita / Cagol, Matteo / Saraceni, Elisabetta / Baratto, Fabio / Castoro, Carlo

World journal of surgical oncology

2014 Volume 12, Page(s) 156

Abstract: Background: The aims of this prospective study were to analyze the predictors of postoperative sleep disturbance after esophagectomy for cancer and to identify patients at risk for postoperative hypnotic administration.: Methods: Sixty two ... ...

Abstract	Background: The aims of this prospective study were to analyze the predictors of postoperative sleep disturbance after esophagectomy for cancer and to identify patients at risk for postoperative hypnotic administration. Methods: Sixty two consecutive patients who underwent cancer-related esophagectomy were enrolled in this study from May 2011 to February 2012. Data about perioperative management, postoperative complications, ICU stay, and vasopressor, hypnotic, and painkiller administration were retrieved. The EORTC QLQ-C30 was used and global quality of life (QL2 item) and sleep disturbance (SL item) were the primary endpoints. Univariate and multivariate analyses were performed. Results: Postoperative request of hypnotics independently predicted bad quality of life outcome. Sleep disturbance after esophagectomy was independently predicted by the duration of dopamine infusion in the ICU and the daily request of benzodiazepines. Even in this case, only sleep disturbance at diagnosis revealed to be an independent predictor of hypnotic administration need. ROC curve analysis showed that sleep disturbance at diagnosis was a good predictor of benzodiazepine request (AUC = 73%, P = 0.02). Conclusions: The use of vasopressors in the ICU affects sleep in the following postoperative period and the use of hypnotics is neither completely successful nor lacking in possible consequences. Sleep disturbance at diagnosis can successfully predict patients who can develop sleep disturbance during the postoperative period.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Disease Management ; Esophageal Neoplasms/complications ; Esophageal Neoplasms/pathology ; Esophageal Neoplasms/surgery ; Esophagectomy/adverse effects ; Female ; Follow-Up Studies ; Humans ; Hypnotics and Sedatives/therapeutic use ; Male ; Middle Aged ; Neoplasm Staging ; Postoperative Complications/drug therapy ; Postoperative Complications/etiology ; Postoperative Period ; Prognosis ; Prospective Studies ; Quality of Life ; Sleep Initiation and Maintenance Disorders/drug therapy ; Sleep Initiation and Maintenance Disorders/etiology ; Surveys and Questionnaires
Chemical Substances	Hypnotics and Sedatives
Language	English
Publishing date	2014-05-21
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2118383-1
ISSN	1477-7819 ; 1477-7819
ISSN (online)	1477-7819
ISSN	1477-7819
DOI	10.1186/1477-7819-12-156
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Article: Intestinal Surgery for Crohn's Disease: Role of Preoperative Therapy in Postoperative Outcome

Scarpa, Marco / Martinato, Matteo / Bertin, Eugenia / Da Roit, Anna / Pozza, Anna / Ruffolo, Cesare / D''Incà, Renata / Bardini, Romeo / Castoro, Carlo / Sturniolo, Giacomo C. / Angriman, Imerio

Digestive Surgery

2015 Volume 32, Issue 4, Page(s) 243–250

Institution	Oncological Surgery Unit, Veneto Institute of Oncology (IOV-IRCCS Department of Surgical Oncological and Gastroenterological Sciences, University of Padova, Padova, and Department of Surgery, Regional Hospital ‘Ca' Foncello', Treviso, Italy
Abstract	Purposes: Patients affected by Crohn's disease (CD) require lifelong medical therapy, but they can also often require abdominal surgery. The effect of CD therapy on postoperative course is still unclear. The aim of this study was to evaluate the effect of preoperative medical therapy on the outcome of intestinal surgery in these patients. Methods: Data from a consecutive series of 167 patients with CD operated on at the University of Padova Hospital from 2000 to 2013 were retrieved. Data of preoperative therapy during the 6 months before surgery were available for 146 patients who were enrolled in this retrospective study. Clinical data and surgical details were retrieved and postoperative complications and reoperation were considered outcome measures. Univariate and multivariate analysis were performed. Results: No significant difference was observed between patients without data about their preoperative therapy and those with them. Eight patients underwent reoperation in the first 30 postoperative days: two of them for anastomotic leak, three for bleeding, one for obstruction and two for abdominal wound dehiscence. At multivariate analysis, preoperative adalimumab and budesonide resulted to be an independent predictor of reoperation (OR = 7.67 (95% CI = 1.49-39.20), p = 0.01 and OR = 6.7749 (95% CI = 0.98-46.48), p = 0.05, respectively). At multivariate analysis neither pharmacological nor clinical variables resulted to predict anastomotic leak. Conclusions: In our series, adalimumab seemed to be associated to early reoperation after intestinal surgery. This may be due to a worst disease severity in patients who needed surgery in spite of biological therapy. Preoperative tapering of budesonide dose seems a safe option before elective abdominal surgery for CD.
Keywords	Budesonide ; Crohnߣs disease ; Intestinal surgery ; Adalimumab
Language	English
Publishing date	2015-05-19
Publisher	S. Karger AG
Publishing place	Basel, Switzerland
Document type	Article
Note	Original Paper
ZDB-ID	605888-7
ISSN	1421-9883 ; 0253-4886
ISSN (online)	1421-9883
ISSN	0253-4886
DOI	10.1159/000381885
Database	Karger publisher's database

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